Variations in patient management and outcomes for acute myocardial infarction in the United States and other countries : results from the GUSTO trial.
- To examine differences in outcomes and patient management between patients in the United States and outside the United States undergoing thrombolysis for acute myocardial infarction.
Design, Setting, and Patients
- Patients in the United States (n=23 105) and 14 other countries (n=17 916) were randomized to receive streptokinase plus either subcutaneous or intravenous (IV) heparin, accelerated recombinant tissue-type plasminogen activator (rt-PA) plus IV heparin, or combined streptokinase and rt-PA plus IV heparin.
- Mortality reduction with accelerated rt-PA vs streptokinase was greater in the United States (1.2% absolute decrease vs 0.7% elsewhere), but the test for treatment-by-country interaction against streptokinase was not significant (P=30).
Benefits of accelerated rt-PA over combination therapy were observed in the United States, but not in other countries (P=02).
Despite differences in baseline characteristics and patient management, 30-day mortality was not significantly different : 6.8% in the United States vs 7.2% elsewhere (P=09).
- No significant evidence for a differentially greater benefit of accelerated rt-PA over streptokinase was found in US vs non-US patients.
However, increased procedure and treatment use in the United States was associated with only a small decrease in short-term mortality.
Mots-clés Pascal : Infarctus, Myocarde, Protocole thérapeutique, Efficacité traitement, Evolution, Monde Ouest, Amérique du Nord, Etude comparative, Traitement, Survie, Epidémiologie, Homme, Amérique, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Therapeutic protocol, Treatment efficiency, Evolution, Western countries, North America, Comparative study, Treatment, Survival, Epidemiology, Human, America, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0364797
Code Inist : 002B30A01C. Création : 01/03/1996.